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PATIENT SUPPORT • 01/17/2019

Methods of colorectal cancer surgery

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ByDr. Ronit Yarden

Surgery is considered the most common treatment for early stage or resectable (removable) colorectal cancers. Doctors will evaluate which type of surgery is best for a patient, depending on the extent of the tumor, and where it is located. The three main types of surgery for colorectal cancer are open, laparoscopic, and robotic.

Historically, open surgery for colorectal cancer has been the conventional method for removing tumors. Recent advancements in technology, however, have enabled more laparoscopic and robotic approaches. These are considered minimally invasive surgeries that let doctors make smaller incisions and can decrease recovery time.

A study of more than a million hospitalized colorectal cancer patients showed a 35.4 percent decrease in open surgery between 2004 and 2012, though it remains the most common type of procedure. Laparoscopic surgeries increased more than three times to 31.2 percent, and robotic surgeries increased more than 41 times, though robotic surgeries have the smallest share of operations at 3.4 percent.

The decision to use minimally invasive surgery or open surgery should be discussed with a patient’s healthcare team. Which type of operation is better for the patient is dependent on numerous factors, including the surgeon’s experience and a patient’s health. Open surgeries can take less time than minimally invasive surgeries, but minimally invasive surgeries usually have a faster recovery time.

Laparoscopic surgery (minimally invasive)

Laparoscopic surgery is a specialized minimally invasive surgery in which the surgeon uses several small abdominal incisions (0.5-1 cm) to insert surgical instruments into the abdominal cavity, as well as a long and thin lighted tube with a camera on the end called a laparoscope. A larger incision, about 3-5 cm wide, is made to remove the tumor. The laparoscope transmits images from the abdominal cavity to high-resolution video monitors in the operating room. Carbon dioxide (CO2) gas is commonly used to inflate the abdomen during minimally invasive surgery to create space for the surgeons to operate. The gas is naturally absorbed or excreted by the body. The surgical instruments function as an extension of the surgeon's hands to dissect and resect the tumor. During the operation, the surgeon observes the abdomen and manipulates the instruments by watching the monitors. The surgeon will remove the segment of the colon or rectum that contains the tumor through the larger incision, along with the attached lymph nodes. The surgeon will check the rest of the intestines and liver to see if the cancer has spread.

Robotic surgery (minimally invasive)

The first robotic colorectal surgery was performed in 2001. Robotic surgery lets surgeons use miniaturized instruments, operated with a console, and a 3D camera to complete an operation from a comfortable seated position with enhanced precision, flexibility, and control. Like in laporascopic surgery, the surgeon uses several small abdominal incisions (0.5-1 cm) to insert the surgical instruments into the abdominal cavity, as well as a long and thin lighted tube with a camera on the end called a laparoscope. A larger incision, about 3-5 cm wide, is made to remove the tumor. The surgeon will remove the segment of the colon or rectum that contains the tumor and the attached lymph nodes. The surgeon will check other segments of the colon and nearby organs to see if the cancer has spread. Robotic operations provide high-quality visuals to the surgeon, but they take longer to perform and may come at a higher cost. Minimally invasive rectal cancer surgeries are often completed robotically.

Open surgery

During open surgery, the surgeon makes a large cut into the abdomen to remove the tumor and part of the healthy colon or rectum. The surgeon will remove the segment of the colon or rectum that contains the tumor and the attached lymph nodes. The surgeon will check other segments of the colon and nearby organs to see if the cancer has spread. The large incisions affect recovery time.

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